How Direct Primary Care Can Save You Money

From the team at Datri MD, Stone Oak

"I already pay for insurance. Why would I pay $150 a month for a doctor too?"

It's the most common question we hear, and it's a fair one. For many people, though, direct primary care (DPC) doesn't add to what they spend on health care. It replaces costs they're already paying, often in ways they don't notice until they add them up.

Here's how that works, and when it might not.

Where everyday care costs add up

With a typical insurance plan, your monthly premium is only the start. Everyday care often comes with more costs on top:

• Copays for every office visit, urgent care trip, and specialist referral.
• Your deductible, which you pay in full before insurance covers much at all. On many plans today, that's thousands of dollars.
• Lab and imaging bills that arrive weeks later, at prices you never saw up front.
• Urgent care or ER visits for problems that could have been handled with a phone call, if you could reach your doctor.
• Time off work for long waits and short visits.

The "free" physical that comes with a bill. Your yearly checkup is usually covered at no cost. But if you bring up a new problem during that visit, like knee pain or a medication question, the office can bill two codes for the same appointment: one for the preventive checkup and one for the problem. The second one can come with a copay or count toward your deductible. Many patients only find out when the bill arrives.

With DPC, there are no billing codes. A checkup that turns into a conversation about your knee costs the same as any other visit: nothing beyond your membership.

None of these show up on your premium statement, but they're real money.

Coming soon: two visits for one problem?

In insurance billing, when a doctor examines a new problem and treats it in the same visit, like evaluating a suspicious spot and then removing it, the office adds a code called "modifier 25" so both services get paid.

That's changing. In July 2026, Medicare proposed paying only half for the exam portion when it happens on the same day as a minor procedure, starting January 1, 2027. Some private insurers, including Blue Cross Blue Shield of Michigan, have adopted or tried similar cuts.

Doctors' groups have warned that this could push offices to schedule a separate visit for the evaluation and another for the treatment. For you, that could mean a second appointment, more time off work, and a second copay. Medicare's final decision is expected later this year.

In a DPC practice, none of this applies. There are no billing codes, so if Dr. Datri can diagnose and treat your problem in one visit, she will.

Where DPC saves you money

No copays for primary care visits. Your membership covers your visits with Dr. Datri. Come in three times in a month or not at all — the price stays the same.

Discounted labs and imaging. When you need outside lab work or imaging, we offer discounted cash prices through third-party labs and imaging centers, and you'll know the price upfront.

Fewer urgent care and ER trips. When you can call or text your own doctor, a lot of "should I go in?" moments get answered without a trip. And when you do need to be seen, scheduling is timely and flexible.

Catching problems early. Longer visits leave time to manage blood pressure, blood sugar, and medications before they turn into expensive complications.

More done in one visit. Common tests are included in your membership and done right in the office: ECGs, spirometry (a breathing test), urinalysis, and handheld ultrasound. Dr. Datri also offers certain injections in the office, and point-of-care A1c testing for diabetes is coming by the end of the year. That means fewer trips to a lab or another office, and faster answers.

Less time lost. Shorter waits and fewer return trips mean fewer hours away from work and family.

The bigger savings: rethinking your insurance

DPC isn't insurance, and you should still have coverage for hospital stays, surgery, and emergencies. But once your everyday care is covered by your membership, some people find they no longer need a plan built around frequent office visits.

That can open the door to a plan with a lower monthly premium, such as a high-deductible plan. The money you save on premiums can help cover your membership.

New in 2026: HSA-friendly DPC. Under a new federal law that took effect January 1, 2026:

• You can pay DPC membership fees with your Health Savings Account (HSA), up to $150/month for an individual or $300/month for a family. HSA dollars go in before taxes, so your membership effectively costs less.
• Having DPC no longer stops you from contributing to an HSA.
• Bronze and catastrophic Marketplace plans can now be paired with an HSA.

At $150/month, a Datri MD membership fits right at the individual limit. Check with your HSA administrator or a tax professional before you switch plans.

Do the math for your own year

Everyone's costs are different, so the best way to know is to add up your own. A Datri MD membership is $150/month, or $1,800 a year for one adult.

Now look back at the last 12 months and total what you spent on everyday care:

1. Copays for primary care, urgent care, and minor-illness visits
2. Primary care visits you paid in full while meeting your deductible
3. Routine lab work you paid for out of pocket
4. Tests like an ECG or breathing test that were billed separately
5. Any ER visit for something your doctor could have handled

Then ask one more question: could a lower-premium plan cover your big risks if your everyday care were handled by DPC? Compare that premium difference too.

If your everyday costs plus the premium savings come close to $1,800, DPC may cost you little or nothing extra — and you get far more time with your doctor.

When DPC may not save you money

We'd rather you choose us for the right reasons. DPC may not lower your costs if:

• You rarely see a doctor and your plan already covers preventive care at no cost. You'd be paying for access you don't use (though many members value having it when they need it).
• Your employer plan has low copays and a low deductible, and you plan to keep it. DPC would add to your costs, even if it improves your care.
• You're on Medicare. Dr. Datri has opted out of Medicare, so Medicare won't pay for her services, and the membership is out of pocket.

In those cases, DPC can still be worth it for the time, access, and relationship, but it's a choice about care, not savings.

See if DPC is right for you

The best way to find out is to meet Dr. Datri. Our free 15-minute meet & greet is a relaxed conversation about your health, your goals, and how DPC works, with no pressure to join.

Call or text for your free meet & greet: (210) 943-9578 · DatriMD.com

540 Madison Oak Dr, Ste 370 · San Antonio, TX 78258

Your doctor. Your time. Your care.

This post is for general information and isn't financial, tax, or insurance advice. Please talk with a licensed insurance agent or tax professional about your own situation.